Evening Salivary Cortisol Levels Research Articles

Salivary Cortisol Levels as a Prognostic Outcome Marker in Patients with Acute Aneurysmal Subarachnoid Haemorrhage

The physiological stress response to aneurysmal subarachnoid haemorrhage (aSAH) may trigger not only beneficial effects. Production of corticosteroids and catecholamines can induce cerebral vasospasm. Cortisol secretion levels were used to assess physiological stress. However, the appropriate measurement method remains controversial. Our study aimed to establish the relationship between cortisol levels measured in the saliva of patients with aSAH, neurological status, and mortality rates. Our study included 128 patients with aSAH treated with endovascular embolization for cerebral aneurysm with a daily examination of the cortisol level in saliva at 08.00 AM and 08.00 PM until ICU discharge or death. Daily salivary cortisol levels, haemodynamic parameters (mean arterial pressure), neurological status, and the level of consciousness (GCS) were monitored. This study included 53 women and 75 men. The mean patient age was 64.2 years (range: 42–77 years). Eighteen (14.06%) patients died. Salivary cortisol levels were significantly higher in deceased patients, both in the morning (31.8 nmol/l for deceased patients vs. 16.8 nmol/l for patients discharged alive; p < 0.001), and in the evening during the follow-up period (5.2 nmol/l for deceased patients vs. 3.6 nmol/l for patients discharged alive; p < 0.001). We found a statistically significant correlation between an increase in morning salivary cortisol levels and neurological deterioration. Similar observations of evening cortisol levels were observed in only five patients. Measurement of salivary cortisol levels in patients with aSAH provides additional information about prognosis. Patients who die during the acute phase of aSAH have higher morning and evening salivary cortisol levels than those who survive. Patients who died demonstrated a progressive increase in salivary cortisol levels in the morning.

Sleep Quality and Evening Salivary Cortisol Levels in Association with the Psychological Resources of Parents of Children with Developmental Disorders and Type 1 Diabetes.

Sleep deprivation can decrease parental well-being and degrade mental and physical health in parents of children with chronic illness. The aim of this study was to explore the associations of sleep quality, psychological stress perception, and evening salivary cortisol concentration with self-esteem, optimism and happiness in parents of children with type 1 diabetes and developmental disorders compared to parents of healthy, typically developing children. We studied 196 parents of children with chronic conditions, including autistic spectrum disorder (N = 33), cerebral palsy (N = 18), Down syndrome (N = 33), and diabetes mellitus type 1 (N = 40) and parents of healthy children (N = 72). We evaluated parental sleep quality, evening salivary cortisol levels, self-esteem, optimism and happiness. Multiple linear regression models were used to assess associations between variables. Compared with those of the control group, the parents of children with autistic spectrum disorders had higher evening cortisol concentrations (β = 0.17; p = 0.038) and lower perceptions of happiness (β=-0.17; p = 0.017), while parents of children with type 1 diabetes had disrupted sleep quality (β = 0.25; p = 0.003). Optimism was negatively associated with the evening cortisol concentration (β=-0.18; p = 0.023) and sleep quality index (β=-0.20; p = 0.012). Public health programs aimed at lifestyle habit improvement, respite care, and relaxation for parents of children with chronic conditions would be useful for improving parental sleep quality, self-esteem, optimism and happiness.

Mekanik ventilasyon modlarının prematüre bebeklerin tükürük kortizol düzeylerine etkisi

Purpose: The aim of this study was to examine the relationship between mechanical ventilation modes and stress levels by measuring salivary cortisol levels in preterm infants.
 Materials and Methods: The study group comprised 65 preterm infants on respiratory support and 43 control preterm infants. The Neonatal Infant Pain Scale (NIPS) was used to evaluate pain. To determine the stress level, salivary cortisol levels were studied in saliva samples taken in the morning and evening on the 4th postnatal day.
 Results: In the study group, morning and evening cortisol levels of the infants were measured 8.33±5.7 ng/ml and 8.05±5.6 ng/ml, respectively. In the control group, morning and evening cortisol values of the infants were measured 1.50±0.7 ng/ml and 1.48±0.7 ng/ml, respectively. The morning and evening salivary cortisol levels of the infants in the study group were significantly higher than those of the infants in the control group. In the invasive mechanical ventilation group infants, morning and evening cortisol levels of the infants were measured 12.46±5,3 ng/ml and 12.0±5,2 ng/ml, respectively. In the non-invasive mechanical ventilation group, morning and evening cortisol values were measured 4.57±2.7 ng/ml and 4.41±2.7 ng/ml, respectively. Both morning and evening salivary cortisol levels of infants on invasive mechanical ventilation were higher than those of infants on non-invasive mechanical ventilation. 
 Conclusion: Increased salivary cortisol levels in invasive modes indicate that intubation causes pain and stress in newborns.

Potential role of salivary cortisol levels to reflect stress response in children undergoing congenital heart surgery.

This study aimed to provide baseline information on the potential role of salivary cortisol in reflecting the stress response in children undergoing congenital heart surgery. Children underwent congenital cardiac surgery, aged between one and seventeen years were included. Saliva samples were collected pre- and postoperatively by the health caregiver immediately after the children woke up (07:00-09:00 am) and at 06:00 pm in the evening. Salivary cortisol levels were compared with the reference index values from a large database. Median baseline preoperative morning salivary cortisol levels were significantly lower than the reference values in both < 5-year-old females (p = 0.01) and males (p = 0.04) and in males between 11 and 20 years of age (p = 0.01). Median baseline preoperative evening salivary cortisol levels were significantly higher than the reference value in < 5-year-old females (p = 0.01) and between 5 and 10 years of age (p = 0.04) and in between 11- and20-year-old males (p = 0.01). Median postoperative morning salivary cortisol levels were significantly lower than the reference value in both < 5-year-old females (p = 0.01) and males (p = 0.04) and females between 5 and 10 year of age (p = 0.04). Median postoperative evening salivary cortisol levels were significantly higher than the reference value in < 5-year-old females (p = 0.01) and between 5- and 10-year-old females (p = 0.04). Diurnal variability of salivary cortisol levels in children undergoing congenital heart surgery may be different from normal reference values both in preoperative and postoperative periods that can be a predictive indicator of anxiety on pre- and postoperative period for children that undergoing cardiac surgery.

Evaluating the Interrelationship Between Salivary Cortisol and Glycemia in Type 2 Diabetics

Introduction: Diabetes mellitus is a multifactorial metabolic condition marked by high blood sugar levels as well as problems with carbohydrate, lipid, and protein metabolism. Impaired insulin secretion and hepatic gluconeogenesis cause high blood sugar levels. Cortisol in the saliva is the unbound, free hormone, with absolute quantities between 30% and 50% fewer than in blood. The aim of the study was to evaluate the levels of salivary cortisol in normal healthy controls and type 2 diabetics. The objective was to evaluate the morning and evening levels of salivary cortisol in normal and type 2 diabetics by enzyme-linked immunosorbent assay (ELISA). Materials and Methods: 20 patients in the age group of 30 to 60 years with type 2 diabetes with HbA1c <6.5% were included in Group I. Twenty participants in the age group of 30 to 60 years were included in Group II. Salivary samples were collected and centrifuged at –4°C at 3500 rpm and ELISA was performed. Data were analyzed using Statistical Package for the Social Sciences version software version 16. Paired sample t test was used. Results: The mean morning salivary cortisol level of diabetic patients (Group I) was 1.62 mmol/dL and the evening was 1.34 mmol/dL. The difference was statistically significant (P = 0.00001). The mean salivary cortisol level of healthy subjects in the morning was 0.47 mmol/dL and evening was 0.29 mmol/dL, which is statistically significant (P = 0.00001). Conclusion: From this study, we can conclude that the salivary cortisol level is increased in patients with type 2 diabetes when compared to healthy individuals. There are no obvious changes in morning and evening salivary cortisol levels of diabetes patients.

Morning and evening salivary cortisol levels in patients with chronic widespread pain and those at high risk.

Hypothalamic-Pituitary-Adrenal (HPA) axis dysregulation has been implicated in chronic widespread pain (CWP); the hallmark of fibromyalgia (FM). This is the first study to compare HPA axis changes in individuals with CWP and those at high risk of symptom development. We sought to determine differences in morning and evening salivary cortisol levels in FM (n=19), those at-risk (n=20) and pain-free controls (n=17). Risk factors included non-CWP pain, somatic symptoms, illness behaviour and sleep disturbance. We conducted the study in the absence of centrally acting medication, to address limitations of previous research. Repeated measures ANOVA revealed significant main effects of group (p=0.003), and time of day (p=0.002), with no significant interaction. Cortisol levels were higher in FM (p=0.027) and at-risk (p=0.003) groups, compared to controls, but there was no significant difference between FM and at-risk groups. The main effect of group remained significant with sleep problems (p=0.021) and life events (p=0.007), but was not significant with anxiety (p=0.076) or depression (p=0.098) scores as covariates. With sleep problems as a covariate, cortisol levels remained significantly higher only in the at-risk group (p=0.017). This study indicates elevated salivary cortisol in FM and those at high risk, and identifies anxiety, depression and sleep problems as potential contributing factors. The results shed light on the dynamic relationship between stress, mood and sleep disorders and the brain's resilience to pain. This study examines neurobiological changes in chronic widespread pain and high risk individuals. One strength of the study is the absence of centrally acting medication. We found high salivary cortisol common to Fibromyalgia and those at risk and identified contributing factors. Our results offer insight into the early mechanistic changes underlying Fibromyalgia development and open up possibilities for early diagnosis and prevention.

Associations between baseline cortisol and trajectory of symptom improvement in depressed adolescents receiving psychological therapy

BackgroundCortisol hypersecretion in depressed adolescents and adults is associated with more persistent illness and may signal a lower response to psychological therapies. A meta-analysis of small and heterogenous studies demonstrated that higher pre-treatment basal cortisol levels were associated with poorer response specifically to psychological therapy for depression. The objective of this study was to investigate the relationship between both morning and evening salivary cortisol levels and response to psychological therapy in depressed adolescents participating in one large randomised controlled trial. MethodsWe tested the association between morning and evening salivary cortisol levels at baseline and improvement in depressive symptoms in response to psychological therapies in depressed adolescents at 6 time points: baseline, 6, 12, 36, 52- and 86-weeks post-randomisation, using the self-reported Mood and Feelings Questionnaire (MFQ). ResultsHigh evening cortisol was associated with a slower initial decline in depressive symptoms (cortisol x quadratic time p = .022); however it was not associated with total change in depressive symtoms over the whole course of the study. Morning cortisol was not associated with change in depressive symptoms. These effects were not significantly different across the three psychological therapies. LimitationsResults may not generalize to adolescents receiving other treatments (medication) or no treatment, and may not generalize to adults. Only a minority of eligible participants collected valid cortisol samples. ConclusionsHigher pretreatment evening cortisol may impair a depressed adolescent's ability to use psychological therapy.

Maternal emotion dysregulation and physiological concordance in mother‐preschooler dyads

AbstractMaternal emotional and physiological dysregulation has been found to influence child stress physiology. This study characterizes diurnal cortisol and basal heart rate variability (HRV) patterns in a predominately high‐risk sample of mothers with a full range of emotion dysregulation and assessed the magnitude of concordance (N = 68 mother‐preschooler dyads). Overall, dyads exhibited concordance in evening salivary cortisol levels, but not for morning levels or HRV. Maternal emotion dysregulation was associated with maternal and child evening cortisol levels, child morning cortisol levels, and maternal HRV. Bootstrapping analyses showed that maternal emotion dysregulation was associated with higher child evening cortisol levels through its impact on mother evening cortisol levels. This study offers preliminary evidence for understanding child stress physiology and dyadic concordance in a sample of mothers with a range of emotion regulation capabilities.Highlights Maternal physiology may explain the association between maternal emotion dysregulation and child physiological patterns. Emotionally dysregulated mothers were oversampled and mothers and children's heart rate variability and cortisol were collected, with findings showing dyadic concordance in evening cortisol. This work highlights the importance of transdiagnostic approaches for examining concordance and child stress physiology.

Relationship between Intrinsically Photosensitive Ganglion Cell Function and Circadian Regulation in Diabetic Retinopathy

Background: Intrinsically photosensitive retinal ganglion cells (ipRGCs) control non-visual light responses (e.g. pupillary light reflex and circadian entrainment). Patients with diabetic retinopathy (DR) show reduced ipRGC function, as inferred by abnormalities in the post illumination pupil response (PIPR). We explored whether ipRGC function in DR is associated with circadian outputs and sleep/wake behavior. Methods: Forty-five participants (15 without diabetes, 15 with type 2 diabetes (T2D) and no DR, 15 with T2D and DR) participated. ipRGC function was inferred from the PIPR (pupil size following stimulus offset). Circadian outputs were melatonin amplitude (overnight urinary 6-sulfatoxymelatonin (aMT6s)) and timing (dim light melatonin onset (DLMO)), and evening salivary cortisol levels. Sleep/wake patterns were measured with wrist actigraphy and insomnia symptoms were assessed subjectively. Results: Patients with T2D and DR had smaller PIPR and lower urinary aMT6s than other groups (p < 0.001). In adjusted regression models, smaller PIPR was associated with lower urinary aMT6s (β = 4.552, p = 0.005). Patients with DR were more likely to have no detectable DLMO (p = 0.049), higher evening salivary cortisol, greater insomnia symptoms and greater sleep variability compared to other groups. Sleep duration, efficiency and rest-activity rhythms were similar. Conclusion: Reduced ipRGC function in DR is associated with circadian dysregulation and sleep disturbances, although a causal relationship cannot be established in this cross-sectional study. Prospective mechanistic and intervention studies examining circadian and sleep health in these patients are warranted.

Salivary cortisol could be a promising tool in the diagnosis of temporomandibular disorders associated with psychological factors

Background: Biopsychosocial models emphasize the multifactorial nature of temporomandibular disorders (TMDs). The role of cognitive, social, and biological factors in the etiology of TMDs has been reported. Aim: To test the salivary cortisol levels in young adults with the temporomandibular joint disorder and having positive depression level and with TMD but with negative depression level and compared with the control group. The correlation between cortisol levels and depression levels according to axis-II of Research Diagnostic Criteria (RDC) was assessed. Settings and Design: The study was a randomized, prospective, and double-blinded study. Materials and Method: The total sample comprised 60 subjects. The study comprised 20 subjects with TMD and depression, 20 subjects with TMDs and without depression, and 20 subjects were taken as the control group. To measure these variables, research diagnostic criteria (RDC/TMJ) were used for the study. Salivary cortisol levels were determined by Enzyme-linked immunosorbent assay (ELISA). Statistical Analysis: A paired t-test, ANOVA, and linear multi regression tests applied to compare the TMD groups with the control group. Results: The results showed that there was a positive correlation between morning and evening salivary cortisol levels in all the groups and the correlation coefficient was 0.729. There was a significantly higher value of salivary cortisol in TMD patients with depression than TMD patients without depression and the control group. Conclusion: Salivary cortisol could be a promising tool in identifying underlying psychological factors that could be associated with TMD.

Relationships Between Pain, Life Stress, Sociodemographics, and Cortisol: Contributions of Pain Intensity and Financial Satisfaction

Objective The relationship between psychosocial stress and chronic pain is bidirectional. An improved understanding regarding the relationships among chronic pain, life stress, and ethnicity/race will inform identification of factors contributing to health disparities in chronic pain and improve health outcomes. This study aims to assess relationships between measures of clinical pain, life stress, sociodemographics, and salivary cortisol levels. Methods A cross-sectional analysis involving data from 105 non-Hispanic White (NHW) and non-Hispanic Black (NHB) participants aged 45–85 years old with or at risk for knee osteoarthritis. Data included sociodemographics, clinical pain, psychosocial stress, and salivary cortisol across five time points over an approximate 12-hour period. Non-parametric correlation analysis, sociodemographic group comparisons, and regression analyses were performed. Results Clinical pain and psychosocial stress were associated with salivary cortisol levels, particularly morning waking and the evening to morning awakening slope. With the inclusion of recognized explanatory variables, the Graded Chronic Pain Scale characteristic pain intensity and financial satisfaction were identified as the primary pain and psychosocial measures associated with cortisol levels. Sociodemographic group differences were indicated such that NHB participants reported higher pain-related disability, higher levels of discrimination, lower financial and material satisfaction, and showed higher evening salivary cortisol levels compared to NHW participants. In combined pain and psychosocial stress analyses, greater financial satisfaction, lower pain intensity, and lower depression were associated with higher morning waking saliva cortisol levels while greater financial satisfaction was the only variable associated with greater evening to morning awakening slope. Conclusion Our findings show relationships among clinical pain, psychosocial stress, sociodemographic factors, and salivary cortisol levels. Importantly, with inclusion of recognized explanatory variables, financial satisfaction remained the primary factor accounting for differences in morning waking cortisol and evening to morning awakening cortisol slope in an ethnic/racially diverse group of middle aged and older adults with or at risk for knee osteoarthritis.

Salivary cortisol levels as a biomarker for severity of withdrawal in opioid-exposed newborns.

Scoring tools used to quantify withdrawal in infants with neonatal abstinence syndrome (NAS) are often confounded by subjective measurements. This study assessed salivary cortisol as an objective biomarker of withdrawal severity in opioid-exposed newborns. A prospective study was conducted in 25 full-term opioid-exposed newborns monitored for NAS. Morning and evening salivary cortisol levels were collected starting within 48 h post birth until initiation of pharmacologic treatment for withdrawal (Pre-Treatment) or when the infant was discharged without pharmacotherapy (No Treatment). Cortisol levels in the Pre-Treatment group (n = 11) were significantly higher within the first week of life (median 1.74 µg/dl) than in the No Treatment group (n = 11; median 0.72 µg/dl; P = 0.003); three infants had inadequate saliva volume for cortisol assay. Cortisol significantly decreased after 72 h post birth among infants discharged without pharmacotherapy (≤72 h median 1.25 µg/dl; ≥72 h median 0.58 µg/dl; P = 0.022), whereas cortisol remained elevated for infants subsequently treated for severity of withdrawal. No cortisol circadian rhythm was observed for either group. Salivary cortisol in opioid-exposed newborns may provide an index of stress and help identify infants who will have more severe clinical presentation of NAS. Such a biomarker would allow risk stratification for early treatment and discharge decisions.

Preoperative Salivary Cortisol AM/PM Ratio Predicts Early Postoperative Cognitive Dysfunction After Noncardiac Surgery in Elderly Patients.

The diagnosis of postoperative cognitive dysfunction (POCD) requires complicated neuropsychological testing and is often delayed. Possible biomarkers for early detection or prediction are essential for the prevention and treatment of POCD. Preoperative screening of salivary cortisol levels may help to identify patients at elevated risk for POCD. One hundred twenty patients >60 years of age and undergoing major noncardiac surgery underwent neuropsychological testing 1 day before and 1 week after surgery. Saliva samples were collected in the morning and the evening 1 day before surgery. POCD was defined as a Z-score of ≤-1.96 on at least 2 different tests. The primary outcome was the presence of POCD. The primary objective of this study was to assess the relationship between the ratio of AM (morning) to PM (evening) salivary cortisol levels and the presence of POCD. The secondary objective was to assess the relationship between POCD and salivary cortisol absolute values in the morning or in the evening. POCD was observed in 17.02% (16 of 94; 95% confidence interval [CI], 9.28%-24.76%) of patients 1 week after the operation. A higher preoperative AM/PM salivary cortisol ratio predicted early POCD onset (odds ratio [OR], 1.56; 95% CI, 1.20-2.02; P = .001), even after adjusting for the Mini-Mental Sate Examination score (odds ratio, 1.55; 95% CI, 1.19-2.02; P = .001). The area under the receiver operating characteristic curve for the salivary cortisol AM/PM ratio in individuals with POCD was 0.72 (95% CI, 0.56-0.88; P = .006). The optimal cutoff value was 5.69, with a sensitivity of 50% and specificity of 91%. The preoperative salivary cortisol AM/PM ratio was significantly associated with the presence of early POCD. This biomarker may have potential utility for screening patients for an increased risk and also for further elucidating the etiology of POCD.

Dynamic evaluation of the hypothalamic–pituitary–adrenal and growth hormone axes and metabolic consequences in chronic insomnia; a case–control study

The stimulability and supressibility of hypothalamo-pituitary–adrenal (HPA) axis and stimulability of growth hormone (GH) axis is not known in chronic insomnia (CI). We aimed to examine the effects of CI on HPA and GH axes by dynamic tests, and metabolic consequences. Eighteen CI patients and 14 controls, without any other accompanying sleep and metabolic disorders and drug usage were enrolled into the study. Serum leptin and ghrelin levels were measured at 08:00 a.m. in the fasting state. Salivary cortisol rhythm (06:00, 12:00, 18:00, 24:00) and oral glucose tolerance test (OGTT) were performed on separate days. Low dose (1 µg) ACTH stimulation, glucagon stimulation test (GST), and dexamethasone suppression test (DST) were performed at 08:00 a.m. leaving 48 h in between. Salivary cortisol levels at 18:00 were found to be significantly higher in CI compared to controls (0.14 ± 0.11 vs 0.08 ± 0.06, respectively; p = 0.027). Basal, peak and area under curve of cortisol responses to dynamic stimulation tests were similar in two groups. Cortisol levels after overnight DST were also similar in two groups. GH responses to GST were not different between groups. Fasting glucose levels, HOMA-IR, OGTT and lipid levels were similar in both groups. The insomnia group had similar leptin and ghrelin levels compared to the control group. Our results indicate that, although CI is associated with elevated evening salivary cortisol levels, neither dynamic feedback regulation of the HPA and GH axis nor leptin and ghrelin levels are affected.

Evening salivary cortisol and alpha-amylase at 14 months and neurodevelopment at 4 years: Sex differences

Stress system activity in early life can have long-term effects on neurodevelopment. The main aim of this study was to assess the association of child evening salivary cortisol and alpha-amylase basal levels at 14months of age with longer-term neuropsychological development at 4years in a low-risk population-based birth cohort derived from the INMA (Environment and Childhood) project in Spain. We included 186 parent-children pairs with information on both stress system activity and neurodevelopment. Both stress markers at 14months of age showed an association with neuropsychological development at 4years. Salivary cortisol showed a sex-specific pattern of association. In girls, cortisol levels at 14months were negatively associated with cognitive development [long-term declarative memory (β=−17.8, p=0.028; 95% CI=−33.2 to −2.5); executive function (β=−9.8, p=0.08; 95% CI=−21 to 1)] and gross motor development (β=−13; p=0.022; 95% CI=−24 to −2), whereas in boys cortisol levels were negatively associated with socioemotional development [autistic-like behaviours: Incidence Rate Ratio (IRR)=1.6, p=0.039; 95% CI=1.01 to 2.41]. Salivary alpha-amylase was positively associated with socioemotional development in boys only [social competence (β=2.11, p=0.013; 95% CI=0.47 to 3.72), autistic-like behaviours (IRR=0.93, p=0.042; 95% CI=0.87 to 0.99) and hyperactivity symptoms (IRR=0.81, p=0.021; 95% CI=0.69 to 0.97)]. These results suggest that stress system activity in early life is associated with longer-term neurodevelopment and that sex is an important factor in this relationship.

Effects of Meditation on Stress Levels of Physical Therapist Students

Background and Purpose. Due to the arduous nature of the professional (entrylevel) physical therapist (PT) education program, PT students often experience higher levels of stress than their age and gender-matched peers, which can negatively affect their academic performance and wellbeing. Therefore, finding methods to manage stress is important for students’ wellbeing and academic success. The purpose of this study was to investigate the effect of meditation on stress levels of students in a doctor of physical therapy program. Participants. Twenty-four PT students in their first and second year of an entry-level doctoral degree program participated in this study. Methods. This study examined the stress levels of 24 subjects via blood pressure, morning and evening salivary cortisol levels, and 3 different stress questionnaires (Perceived Stress Scale, General Anxiety Disorder 7, Stress Visual Analog Scale) using a quasi-experimental pretest-posttest design. The intervention was a twice-daily 20-minute beeja mantra-based meditation performed for 8 weeks. Results. All 24 students completed the study with average compliance of 91.6% ± 8.7% (mean ± SD) meditating at least once per day, and 77.3% ± 19.8% meditating twice per day. A paired t test was used to analyze the blood pressure readings, with systolic blood pressure decreasing by 2.9 ± 2.3 (standard error of the mean: SEM) mmHg (P = .022), and diastolic blood pressure decreasing by 4.6 ± 2.9 (SEM) mmHg (P = .005). Four subjects with prehypertensive systolic blood pressure readings prior to the meditation intervention moved into healthy normal range by the conclusion of the study. The Wilcoxon signed rank test was used to evaluate the questionnaires, which showed significantly decreased subjective stress levels (P < .05). No significant changes in mean morning (AM) or night (PM) salivary cortisol levels were found (P > .05). However, 9 of the 14 (64%) subjects who had at least 1 cortisol measurement outside of the normal range (established by ZRT Labs) at the start of the study had both AM and PM cortisol levels in the normal range following the intervention. Discussion and Conclusion. The results of this study show that an 8-week mantrabased meditation program significantly reduces blood pressure, significantly reduces perception of stress based on the subjective questionnaires, and that a 1-day AM/PM cortisol sample may not be sufficient to accurately analyze a subject's true daily cortisol level to show statistical change.

Prenatal and Postpartum Evening Salivary Cortisol Levels in Association with Peripartum Depressive Symptoms.

BackgroundThe biology of peripartum depression remains unclear, with altered stress and the Hypothalamus-Pituitary-Adrenal axis response having been implicated in its pathophysiology.MethodsThe current study was undertaken as a part of the BASIC project (Biology, Affect, Stress, Imaging, Cognition), a population-based longitudinal study of psychological wellbeing during pregnancy and the postpartum period in Uppsala County, Sweden, in order to assess the association between evening salivary cortisol levels and depressive symptoms in the peripartum period. Three hundred and sixty-five pregnant women from the BASIC cohort were recruited at pregnancy week 18 and instructed to complete a Swedish validated version of the Edinburgh Postnatal Depression Scale at the 36th week of pregnancy as well as the sixth week after delivery. At both times, they were also asked to provide evening salivary samples for cortisol analysis. A comprehensive review of the relevant literature is also provided.ResultsWomen with postpartum EPDS score ≥ 10 had higher salivary evening cortisol at six weeks postpartum compared to healthy controls (median cortisol 1.19 vs 0.89 nmol/L). A logistic regression model showed a positive association between cortisol levels and depressive symptoms postpartum (OR = 4.1; 95% CI 1.7–9.7). This association remained significant even after controlling for history of depression, use of tobacco, partner support, breastfeeding, stressful life events, and sleep problems, as possible confounders (aOR = 4.5; 95% CI 1.5–14.1). Additionally, women with postpartum depressive symptoms had higher postpartum cortisol levels compared to both women with depressive symptoms antenatally and controls (p = 0.019 and p = 0.004, respectively).ConclusionsWomen with depressive symptoms postpartum had higher postpartum cortisol levels, indicating an altered response of the HPA-axis in postpartum depression.

Salivary cortisol, brain volumes, and cognition in community-dwelling elderly without dementia.

We investigated the associations of morning and evening salivary cortisol levels with regional brain volumes and cognitive functioning in community-dwelling older persons without dementia. From the Age, Gene/Environment Susceptibility (AGES)-Reykjavik Study, we included 4,244 persons without dementia (age 76 ± 5 years, 58% women) who had 1.5T brain MRI, assessment of cognitive functioning, and saliva collected at home 45 minutes after awakening and at night. Linear regression analysis was used to estimate the cross-sectional relationship among cortisol levels, brain volumes, and cognitive functioning, adjusting for covariates. Higher evening cortisol was associated with smaller total brain volume (highest vs lowest tertile -16.0 mL; 95% confidence interval -19.7 to -12.2 mL, adjusted for age, sex, education, intracranial volume, smoking, steroid use, white matter lesions, and brain infarcts on MRI). The smaller volumes were observed in all brain regions, but were significantly smaller in gray matter than in white matter regions. Poorer cognitive functioning across all domains was also associated with higher evening cortisol. Higher levels of morning cortisol were associated with slightly greater normal white matter volume and better processing speed and executive functioning, but not with gray matter volume or with memory performance. In older persons, evening and morning cortisol levels may be differentially associated with tissue volume in gray and white matter structures and cognitive function. Understanding these differential associations may aid in developing strategies to reduce the effects of hypothalamic-pituitary-adrenal axis dysfunction on late-life cognitive impairment.

Relationship between vagal tone, cortisol, TNF-alpha, epinephrine and negative affects in Crohn's disease and irritable bowel syndrome.

Crohn’s disease (CD) and irritable bowel syndrome (IBS) involve brain-gut dysfunctions where vagus nerve is an important component. The aim of this work was to study the association between vagal tone and markers of stress and inflammation in patients with CD or IBS compared to healthy subjects (controls). The study was performed in 73 subjects (26 controls, 21 CD in remission and 26 IBS patients). The day prior to the experiment, salivary cortisol was measured at 8∶00 AM and 10∶00 PM. The day of the experiment, subjects completed questionnaires for anxiety (STAI) and depressive symptoms (CES-D). After 30 min of rest, ECG was recorded for heart rate variability (HRV) analysis. Plasma cortisol, epinephrine, norepinephrine, TNF-alpha and IL-6 were measured in blood samples taken at the end of ECG recording. Compared with controls, CD and IBS patients had higher scores of state-anxiety and depressive symptomatology. A subgroup classification based on HRV-normalized high frequency band (HFnu) as a marker of vagal tone, showed that control subjects with high vagal tone had significantly lower evening salivary cortisol levels than subjects with low vagal tone. Such an effect was not observed in CD and IBS patients. Moreover, an inverse association (r = −0.48; p<0.05) was observed between the vagal tone and TNF-alpha level in CD patients exclusively. In contrast, in IBS patients, vagal tone was inversely correlated with plasma epinephrine (r = −0.39; p<0.05). No relationship was observed between vagal tone and IL-6, norepinephrine or negative affects (anxiety and depressive symptomatology) in any group. In conclusion, these data argue for an imbalance between the hypothalamus-pituitary-adrenal axis and the vagal tone in CD and IBS patients. Furthermore, they highlight the specific homeostatic link between vagal tone and TNF-alpha in CD and epinephrine in IBS and argue for the relevance of vagus nerve reinforcement interventions in those diseases.

Blunted Diurnal Cortisol Pattern Is Associated With Frailty: A Cross-Sectional Study of 745 Participants Aged 65 to 90 Years

The role of neuroendocrine alterations in the etiology of frailty syndrome is still poorly understood. Hypothalamic-pituitary-adrenal axis dysregulation is a plausible candidate pathway contributing to frailty. Thus, we sought to examine the associations of diurnal cortisol secretion with frailty in older adults. A cross-sectional analysis was conducted among 745 study participants (age 65-90 years, mean age 75.1 years) of the population-based KORA Age study. Associations between salivary cortisol measures at awakening (morning 1 [M1]), 30 minutes after awakening (M2), and evening (E) and frailty criteria were determined. Lower cortisol levels in the first morning sample (M1) (P = .18) and M2 (P = .14) and increased E levels (P = .004) were observed in prefrail (35.17%, n = 262) and frail (3.36%, n = 25) individuals, in a dose-response manner. Frailty was strongly associated with smaller ratios of morning to evening levels; M1 to E ratio (P = .02) and M2 to E ratio (P = .003). Higher evening cortisol levels were associated with a 24% increased risk of a prefrail state (odds ratio, 1.22; 95% confidence interval, 1.03-1.44). A smaller morning to evening ratio was associated with an increased risk of low grip strength (1.42, 1.09-1.86) and gait speed (1.31, 1.02-1.68). Frailty status is associated with blunted cortisol reactivity as demonstrated by lower morning and higher evening salivary cortisol levels.